Serum apolipoprotein C-II is prognostic for survival after pancreatic resection for adenocarcinoma

A. Xue, J. W. Chang, L. Chung, J. Samra, T. Hugh, A. Gill, G. Butturini, R. C. Baxter, R. C. Smith*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

13 Citations (Scopus)


Background: Pancreaticoduodenectomy remains a major undertaking. A preoperative blood test, which could confidently predict the benefits of surgery would improve the selection of pancreatic cancer patients for surgery. This study aimed to identify protein biomarkers prognostic for long-term survival and to validate them with clinico-pathological information.

Methods: Serum from 40 preoperative patients was used to train for predictive biomarkers using surface-enhanced laser desorption/ionisation time-of-flight mass spectrometry (SELDI), and the results were verified on 21 independent samples. Two predictive proteins were identified by tryptic peptide mass fingerprinting and sequencing, and validated on serum from another 57 patients by enzyme-linked immunosorbent assay (ELISA). The influence of these proteins on growth and invasion of two cancer cell lines was tested in-vitro.

Results: The SELDI panel of m/z 3700, 8222 and 11 522 peaks predicted 12 months survival (ROC AUC: 0.79, 0.64-0.90; P0.039). When CA19-9 was added, the ROC AUC increased to 0.95 (0.84-0.99; P<0.0001). The six subjects in the verification group who died within 12 months were correctly classified. The m/z 8222 and 11 522 proteins were identified as Serum ApoC-II and SAA-1, respectively. In the validation samples, ELISA results confirmed that ApoC-II was predictive of survival (Kaplan-Meier P<0.009), but not SAA-I. ApoC-II, CA19-9 and major-vessel involvement independently predicted survival. ApoC-II and SAA-1 increased cell growth and invasion of both cancer cell lines.

Conclusion: Serum ApoC-II, CA19-9 and major-vessel invasion independently predict survival and improves selection of patients for pancreaticoduodenectomy.

Original languageEnglish
Pages (from-to)1883-1891
Number of pages9
JournalBritish Journal of Cancer
Issue number11
Publication statusPublished - 20 Nov 2012
Externally publishedYes


  • apolipoproteins
  • biomarkers
  • pancreatic neoplasms
  • pancreaticoduodenectomy
  • prognosis
  • survival


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